Inspection on 24/11/06 for 179, Green Lane

This inspection was carried out on 24th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

179, Green Lane 30/07/07

179, Green Lane 16/02/06

179, Green Lane 14/06/05

179, Green Lane 31/08/04

179, Green Lane 27/04/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 179, Green Lane Morden Surrey SM4 6SG Lead Inspector Janet Pitt Unannounced Inspection 24th & 28th November 2006 12:10 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 179, Green Lane Address Morden Surrey SM4 6SG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8648 1307 www.caremanagementgroup.com Care Management Group Limited Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Female adults with Learning Disabilities Psychological needs and behavioural problems Date of last inspection Brief Description of the Service: 179 Green Lane is a care home with nursing, providing care to five females who have mental health needs. The home is situated close to public transport links and a small number of local shops. Accommodation is provided over two floors, with en-suite rooms for each resident. There is also a well-maintained garden to the rear of the property. Fees range from 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection. Two site visits were made which lasted a total of five hours. The majority of one of the site visits was spent talking with clients. Staff files, training records and care documentation was examined. A tour of the premises was undertaken. The inspector spoke with the manager and four members of staff during the site visits. Five client and ten staff surveys were left with the service. Three staff and part of one client survey were returned. What the service does well: What has improved since the last inspection? What they could do better: A plan of routine redecoration and repairs is required, to make sure that clients live in a well-maintained environment. Staff have stated that a conservatory would allow more room for activities within the home and provide additional space for client use. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. EVIDENCE: All clients have been in 179 Green Lane for over two years, some have been in the home since it opened. Two care plans were selected at random and examined. Both had full detailed assessments of the clients and identified risk areas such as absconding. The assessments contained information on personal wishes of the clients, for example whether they wished to undertake formal education. Each plan included detail on developing independent living skills, with realistic timescales for evaluation. Input from other health professionals such as psychiatrists and counsellors was also included in the assessments. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a strong belief that it is essential to involve clients in the planning of care that affects their lifestyle and quality of life. Staff have skills and ability to support and encourage clients to be involved in the ongoing development of their plan. A key worker system enables staff to establish special relationships and work on a one to one basis. EVIDENCE: Both client plans examined had regular evaluations and review meetings. Any changes required were noted and acted upon. There was evidence of good involvement of clients in this process. Individual needs are taken into account, expectations of both staff and clients are set out within the plans, and these included areas such as sexual relationships, health checks and appropriate behaviour. Each clients has a key worker and an individual plan for the week, which covers personal care, time to do laundry and ironing and pursuit of personal 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 10 interests. At various times during the week clients attend a local day centre. The personal plans included free time and staff were observed to be flexible. For example they offered encouragement for a client to attend the day centre, but did not force them to go. Care plans are now handwritten, there was a requirement made at the previous inspection regarding the delay in updating records, because information was being sent away to be computerised. However, it would benefit both staff and clients to have a computer in the home. This would allow staff to maintain records. It would enable clients to access the Internet and use programmes to develop their computer skills. A requirement to make sure verbal aggression is dealt with appropriately from the previous inspection has been complied with. Staff reported that training had been received which makes sure that they are able to deal with incidents in a consistent manner. This was evidenced during one of the site visits when a client exhibited challenging behaviour. Clients are able to take risks. Individualised assessments were noted to be in place for activities such as bathing, crossing roads, going out alone and inappropriate sexual behaviour towards staff. Each had clear details of what is an acceptable risk for clients to take. One client has progressed from needing two staff to support them when going out, to being able to go out alone safely. This has been achieved over a period of years. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to enabling clients to develop their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals and work to achieve them. Where appropriate clients are involved in the domestic routines of the home. EVIDENCE: Clients’ plans showed that they are able to participate in activities of their choosing. The day centre offers a choice of activities, which includes cookery and dance movement therapy. Support is given by staff for those who need it when they go shopping. On one of the site visits a member of staff was helping to wrap Christmas presents for a client. The manager and staff confirmed that arrangements had been made for clients to visit relatives and friends over the Christmas period if they chose. Some clients said that they were staying at 179 Green Lane for Christmas. The staff and manager were seen discussing what the clients would like to do at this time. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 12 One client said that they have regular contact with their mother and staff make sure that the client is taken to their mother’s home and collected again after an overnight stay . The organisation that owns the home was arranging a Christmas party for the clients of 179 Green Lane and other homes that they own. Clients are able to maintain relationships with significant others if they chose. Relationship and sexual needs are addressed in plans. Support in the form of regular health checks is given. Privacy and respect for clients’ relationships is given by staff. It was observed that staff and clients were able to discuss sensitive issues openly. Records of the weekly meeting indicated that clients are offered a choice of food and are able to voice their preferred options. One client said that they liked being taken to a restaurant as they ‘did not have to help cook the meal and were waited on.’ The three staff surveys received indicated that there is fresh produce available and staff are able to eat meals with clients. Records kept of daily activities showed that clients are able to go out for meals when they chose. Clients were supported on the site visits to make their lunch and drinks. One client kindly made the inspector a cup of coffee. A record of food served is kept. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff understand the key principles of giving personal support and are responsive to the varied and individual requirements of the clients. Staff are sensitive to changing needs of clients. Medications are handled and administered in a satisfactory manner. EVIDENCE: Records showed that clients are supported to maintain hygiene needs with staff support. Staff assist clients in shopping for clothing and making sure that clothes are laundered and ironed. All clients’ plans included goals for promoting independent living skills, which covered the areas of self-care, personal care, activities and moods and emotions. Staff were observed to support clients in a calm manner and modelled acceptable behaviour. Religious needs of clients are noted in their plans and they are able to attend services if they chose. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 14 None of the current clients were able to maintain control of their medications. Clients are protected from harm by good medication procedures within the home. Clear records are maintained into and out of the home. There were instructions for ‘as required’ medications, detailing when they should be given. No gaps in recording of administration were noted. The manager informed the inspector that a pharmacist from the pharmacy, which supplies medications to the home, would soon be undertaking an audit. A copy of this audit has been requested (see requirement section). Discussion at one point during the site visit concerned death. One client informed the inspector that a significant person in their life had recently died. It was noted that staff present dealt with the situation sensitively and enabled the client to express their feelings. Staff reported that the client had been able to attend the funeral and chose a floral tribute. Two clients stated that they did not wish to be buried or cremated when they died. This prompted further discussion around death and dying. Clients’ wishes in respect of end of life care were noted to be documented in their plans. If they chose not to discuss this issue this was also documented. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open culture, which enables clients to express their views, and concerns in a safe non-blame environment. Staff are aware of Adult Protection Procedures and when the procedure should be implemented. EVIDENCE: Staff stated that all clients are informed of the complaints procedure on admission to the home. Appropriate leaflets and posters were available in the home detailing the procedure. Minutes of meetings indicated that clients are able to express their views and raise any concerns they may have. It was noted that any issues raised were followed up and acted upon. Some issues related to communication between the clients. Recorded outcomes evidenced that staff made sure that clients were supported to maintain good relationships with each other. Staff stated that they are aware of Protection of Vulnerable Adults (POVA) procedures. There have been no investigations under POVA procedures during the past year. The manager said that he was aware of making sure that there are clear boundaries, to protect staff from being falsely accused of inappropriate behaviour. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the clients who live there. The lay out and design of the home allows for the clients to live together in a non-institutional environment. Clients are encouraged to personalise their rooms. EVIDENCE: Clients live in a home, which is comfortable and homely. 179 Green Lane is a residential property, which has been adapted for clients. There are handrails available on the stairs and all rooms have ensuite facilities. The décor and furnishings are of a homely nature and clients are able to choose how they furnish their rooms. There is good provision of communal space, which in the view of the staff would be further enhanced by a conservatory. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 17 Minor repairs noted at the previous inspection have been dealt with. However, areas of the home require redecoration and repair. The kitchen, lounge and dining room were noted to have a good state of repair and décor. The downstairs toilet had some holes where pipes had been. Scuffmarks were seen on skirting boards and walls. An ongoing redecoration programme must be submitted to the CSCI. 179 Green Lane was clean and tidy on the days of the site visits. Clients are supported to keep their rooms clean and tidy. Staff make sure that communal areas are clean. All clients are expected to assist with cooking, laundry and dishwashing; this is agreed in their plans. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 24 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients have confidence in the staff that care for them, The service has a good recruitment procedure that clearly defines the process to be followed. This procedure is followed on practice. Staff are appropriately supervised and notes are taken of meetings and sessions. EVIDENCE: The home has a new manager in place, who is in the process of applying to the CSCI to be registered. The manager stated that he has been in the home since May 2006 and originally was on a temporary contract. This was because the home caters for female clients and the company that owns the home wanted to be sure that there were no issues with introducing a male member of staff. Clients spoken with said that they liked the manager. Staff surveys received indicated that the manager is supportive of staff and supervision is occurring regularly. Staff files examined had supervision contracts and notes of staff supervision sessions. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 19 Training needs must be reviewed for all staff members to make sure that the training provided is current and meets staff needs. The home has good recruitment procedures in place and all necessary checks are carried out prior to the employee starting work. This was evidence in staff files. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is person centred in their approach and is regarded highly by staff. Clients’ views are sought on the running of the home and acted upon if required. EVIDENCE: The clients are supported by a competent manager who has the necessary skills and experience. Staff surveys indicated that they are supported by the manager and are able to participate in the running of the home. Clients are able to voice their opinions on the running of the home. The manager stated that he is implementing a Quality Assurance System that will include clients, staff, stakeholders and other agencies involved with the home. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 21 The system will cover the environment, staff team, dignity and respect, communication and choice. The structure will be around empowerment, normalisation, holistic care and development of independence for clients. Clients are able to manage their own finances if they chose otherwise staff would provide assistance. The focus of the care given at 179 Green Lane both protects and promotes clients well being. One client stated that they regard 179 Green Lane as ‘their home’. Another client was keen to talk about their experiences in the home and said that they ‘were happy’ and able to do what they wanted. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Requirement The registered person must ensure that a copy of the audit undertaken by the visiting pharmacist is sent to the CSCI. The registered person must provide the CSCI with a programme of ongoing redecoration and repair for the home. The registered person must ensure that training needs for all staff members are reviewed and appropriate training is implemented, to make sure that staff training is current. Timescale for action 28/02/07 2 YA24 23 (2) (b) 28/02/07 3 YA32 18 (1) (c) (i) 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA24 Good Practice Recommendations It is recommended that provision of a computer in the home would enhance the lives of clients and enable staff to maintain records. It is recommended that consideration be given to building DS0000019094.V320132.R01.S.doc Version 5.2 Page 24 179, Green Lane a conservatory to provide additional communal space. 179, Green Lane DS0000019094.V320132.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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